What Parents and Providers Need to Know About HIV Risk and Teens

Introduction

The average teenager feels as if she or he could not possibly get HIV. Most believe that HIV only happens to other people. However, many teens are getting infected and are now living with HIV (HIV+). All teens need to take HIV seriously, get educated, and be tested if they have sex or use drugs.

Risk Factors

Teens and young adults make up the largest number of HIV cases reported in recent years. Globally, UNAIDS estimates that a young woman is newly infected with HIV every minute. Young women account for more than six in ten young people living with HIV worldwide. In many countries, girls and young women have few or no privileges in the economic and social structures of their communities. As a result, they often have less access to HIV testing and treatment as well as to prevention measures, such as condoms and negotiating for safer sex. Moreover, less than a third of young women worldwide have correct and thorough knowledge about HIV.

Violence against girls and women also contributes to the number of young women who are living with HIV. UNAIDS reports that between 11 and 48 percent of the first sexual experiences of adolescent girls (less than 15 years old) were forced. In addition, early marriage is still common in many parts of the world. Adolescent girls who marry and become sexually active are more likely to drop out of school, have less ability to get and understand important health information, and have greater chances of becoming infected with HIV. Adolescent girls who get married often marry against their will and marry older men; these older men are more likely to have been exposed to HIV through sexual activity or injection drug use and therefore expose their young brides to HIV as a result.

In the US, the Centers for Disease Control and Prevention (CDC) estimates that, although young people ages 13 to 24 number fewer than one in five people generally, they account for more than one in every four new HIV infections. It is estimated that more than half of all youth living with HIV do not know they are infected.

One of the groups most at risk for HIV in the US is young men who have sex with men (MSM). In 2010, over seven in ten new HIV infections in young people ages 13 to 24 occurred as the result of male-to-male sexual contact. MSM who become infected may spread the virus to women as well as to men.

MSM are particularly at risk for several reasons:

There are high numbers of MSM living with HIV; therefore, they face a greater risk of being exposed to HIV each time they have sex

Many MSM use alcohol and street drugs, which increases their likelihood of risky sexual behaviors

Young MSM may incorrectly believe that HIV is no longer a serious health problem because of advances in treatment

Social stigma and fear of homosexuality have deep and direct negative effects on the health of MSM. Negative cultural messages about MSM can lead MSM to think poorly about themselves and make unhealthy decisions, including those about sex and substance use. Stigma and discrimination may also make MSM less willing to access HIV prevention and care, or may isolate them from family, friends, and other community support networks.

Teens and Sex

Let's face it -- teens are having sex. In the US, nearly one-half of high school girls say they have had sexual intercourse, yet only slightly more than one in ten (13 percent) of them have ever been tested for HIV. One of the most common ways HIV is passed among teens is through unprotected sex. Teens are less likely to use a condom during vaginal or anal intercourse than sexually active adults. Among sexually active US high school students, only about two out of every five used a condom the last time they had sex. This is a key factor in why so many new HIV infections occur among youth and young adults.

Not using condoms also puts teens at risk for other sexually transmitted diseases or infections (STDs or STIs). In fact, one in every four STDs each year occurs among teens. This is especially concerning because the presence of an STD greatly increases a person's chances of getting or passing on HIV. People who have an STD such as syphilis, genital herpes, chlamydia, or gonorrhea are at greater risk for getting HIV during sex with partners living with HIV. Regularly using condoms significantly reduces the chances of getting STDs.

Minorities and Young Women in the U.S.

Teens living with HIV come from all different backgrounds; however recent studies show that over half of all newly infected American youths are African-American, even though only 17 percent of all US teens are African-American.

Unlike young men, the vast majority of young women get HIV through heterosexual sex (sex between a male and female). Young black women ages 13 to 24 accounted for almost six in ten new HIV infections among US teens and young adults in 2010.

Certain factors may put young women at higher risk for sexually transmitted HIV:

Not being aware of their partners' risk factors

Lack of power in relationships

Having sex with older men who are more likely to be living with HIV

HIV is transmitted from men to women much more easily than from women to men

Younger women have a less mature genital tract that may be more likely to get tears or abrasions during vaginal intercourse

A younger woman's cervix (entrance to the womb) is still developing until age 18. A young woman's "immature cervix" is one with thinner cells that provides less of a barrier to HIV than the cervix of an older, mature woman.

Alcohol and Drug Use

Young people in some countries, including the US, use alcohol and drugs at high rates. Many teens are curious about drugs and feel pressure from peers to try them. Teens are more likely to engage in high-risk behaviors, such as unprotected sex, when they are under the influence of drugs or alcohol.

In 2011, almost one in four sexually active American high school students drank alcohol or used drugs before the last time they had sex. Runaways and other homeless young people are at high risk for HIV infection if they trade sex for drugs or money.

Drug use can also increase the risk of HIV infection if needles are shared. This includes using needles for injecting drugs, injecting steroids, piercing the ears and body, and tattooing.

Talking to Your Teen About HIV

Teens hear about HIV at school, from friends, and on the TV, radio, and Internet. They generally know some basic information. However, what they know may be incorrect and many teens would like to know more. Teens need accurate, age-appropriate information that includes the following:

What HIV is and how it is spread

How to protect themselves

Where to get tested for HIV

How AIDS differs from HIV

How to talk with their parents and partners about HIV/AIDS

How to use a condom correctly

How to make healthy choices about abstinence or sexual activity

Parents can make a difference. CDC research has shown that it is important for parents to talk early and clearly to their children about sex and values. Ongoing conversations about sex, HIV, STDs, and pregnancy prevention can help teens wait until they are older to have sex and make responsible decisions about sexual behaviors when they do start having sex. Awareness, education, and communication can reduce the risk of teens becoming infected with HIV.